Alzheimer's

Gown and Gloves Vital Signs Manual Handling for Healthcare Safe Lifting Techniques Training A Message from the President of the United States

Our goal is to keep our clients healthy

Caring for patient with Alzheimer's... MUSIC IS MAGIC; Therapeutic, Facilitates choice making, avoid crisis when used strategically. Must be appropriate to the individual, not to you.

Back Safety for Healthcare Provide Mouth Care Bathing a patient with dementia/Alzheimer's Dr. Laurel Coleman speaks about Alzheimer’s Disease.

Patients Compassion

We help to assist clients washing face and hands, making beds ,sweeping  and cleaning, this task can be done frequently and can be done useful to interrupt periods of anxiety and to redirect. Participation merits rewards and applause.

Partial bath Bathing and Dressing Bathing Skills Demonstration Voices of Alzheimer's caregivers

Maintain orientation to time/place/person

Use photo albums and videos; reminiscence therapy; picture box; photo wall plaques outside one's bedroom door. Maintain sensory processing of colors (same, different or matching), smells/fragrances; textures. Maintain level of activity - singing and dancing, sitting exercises, walking to the mail box or on the jogging course, clapping in time to music and moving in rhythm; bringing dishes to sink, sweeping, dusting, cleaning. Use preventive adaptive devices like alarms to avoid having to confront unsafe wandering.

Basic Considerations:

  • Is the area well lit. A darkened area or shadowed area can be scary to someone with Alzheimer's and may be the reason they are resistant to move In that direction.
  • Avoid black or dark blue or green as a backdrop. These colors appear as holes that someone will drop into to a person with Alzheimer's, Adding a white or yellow blanket to a black car seat can be much more inviting and manageable.
  • Limit clutter. Place only necessary items in visual field. This will help to direct focus and avoid confusion.
  • Routine is best. Offer similar routine with little variation. Use the senses to precue... same music, same shampoo for smell etc. Limit choices

Dining:    

  • Importance of retaining skill. Research shows that self feeders are safer than those who are fed
  • Need to limit clutter, place only necessary items on table
  • Color contrast importance
  • May need to initiate with hand over hand and then encourage self feed. HOH can serve as a pre-cue.
  • Need for maintaining routine. Smells of cooking food can serve as a precue.
  • Modification of texture and equipment may be necessary to keep dining safe.
  • Safety... make sure the person Is alert and awake
  • Lighting is key provide ample lighting and avoid black or dark backgrounds.

Transfers and Transitions:    

  • Pre-cue to activities such as giving a direction of movement... "Lef s get your coat" with coat at arms reach, or using a cup to head toward the kitchen. Limit conversation and provide a simple invite and object precue. Holding out a sweater in preparation for someone to put it on can help to cue to the task.
  • Feet on the floor will help with rising to stand or transfers. The cue of feet on the floor is a natural for standing.

 

Shamrocks Daffodils and Roses
Shamrocks

-       This group will have a BCRS of 4 -5. They want a familiar routine and schedule. They will ask what I can do next. They can follow simple instructions if demonstrated one step at a time. They can not be reasoned with so do not argue with them. They are unable to adjust their pace and have poor safety awareness.

-       AOL focus - set them up and keeps a consistent routine that enables the resident to complete SO - 75 % of ADSL's given cues. We must provide a consistent routine with sequencing and repetition. We need to reduce steps as able and provide cues for errors and thoroughness of hygiene. Long term repetitive training equals improved performance.

-       Activity focus should be Social activities and cognitive stimulation.

Daffodils

-       This group will have BCRs of 5 - 6. They like to do things with their hands. They have a one minute attention span. They can only se 12-14 inches in front of them they have no side vision. They only understand 4 out of every five words spoken. They need constant cues to move to the next step or just to keep going. It can take them up to three weeks to learn a ne location.
-       ADL focus - they can feed themselves with verbal cues. Ask the resident to perform the task while you are initiating the task. Ex. Ask them to brush their teeth while you are handing them the toothbrush. Keep your sentences short and to the point. Use simple adaptive equipment that does not require new learning.
-       Activity - focus they like to do things with their hands. They like to organize, sort match and fold. They like to take things apart and put them together.

Roses

-       This group will have a BCRS of over 6. They like gross motor activities such as walking or rocking. They like music. They do not know what to do with objects so they may put things in their mouths. They are unable to reply to verbal request. They only pay attention to things with in their vision or have movement
-       ADL focus - dependent in ADL's may respond well to hand over hand. They may do well with finger foods. They may also need to be fed.
-       Activity focus - Sensory stimulation, music and movement

 

Definition:

* Alzheimer's disease is a neurodegenerative disease of the brain characterized by a clinical dementia with prominent memory impairment and specific microscopic pathology including senile plaques and neurofibrillary tangles.

Prevalence:

* Either alone or in combination with other disorders, Alzheimer's disease is the cause of approximately 75% of dementia cases.

* Alzheimer's disease becomes more prevalent with age, although it is not part of normal aging. Genetic risk: * Family history of Alzheimer's disease in a first-degree relative increases the risk approximately twofold.

Cognitive symptoms:

* After memory loss, other symptoms develop including word- finding and visuospatial difficulties, and frontal/executive dysfunction including problems with reasoning and judgment.

Diagnostic criteria:

* Two widely accepted sets of diagnostic criteria are from the NINCDS-ADRDA and the DSM-IV.

* Both criteria require: (1) presence of dementia, (2) deficits in multiple cognitive areas, (3) gradual onset and progression, and (4) ruling out other causes of dementia.

Behavioral symptoms:

* Behavioral and psychiatric symptoms may develop early, including apathy, irritability, agitation, anxiety, and exacerbation of premorbid personality traits.

Treatment:

* Cholinesterase inhibitors are US Food and Drug Administration (FDA) approved for the treatment of mild, moderate, and severe Alzheimer's disease.

* Memantine is FDA approved for the treatment of moderate and severe Alzheimer's disease.

* The behavioral and psychiatric symptoms of Alzheimer's disease are often more distressing to caregivers than the cognitive ones, and should also be treated.

Top differential diagnoses:

* Normal aging, mild cognitive impairment, dementia with Lewy bodies, vascular dementia, frontotemporal dementia.

* Memory Loss: A Practical Guide for Clinicians.

FUTURE TREATMENTS OF MEMORY LOSS

Disease-modifying treatments:
neurofibrillary tangles

Symptomatic and disease - modifying treatment

* Alzheimer's disease can be treated either to improve symptoms and function or to slow disease progression.
* Symptomatic treatments work by altering neurotransmitter function.
* Most disease-modifying treatments are aimed at decreasing β-amyloid protein in the brain.
* Some disease-modifying treatments in development are directed against neurofibrillary tangle formation.

Disease-modifying treatments: amyloid plaques

The amyloid cascade hypothesis describes how a build-up of β-amyloid can lead directly to amyloid plaques, neurofibrillary
tangles, neurotransmitter disruption, and dementia. Approaches to decrease β-amyloid have included active immunotherapy, passive immunotherapy, and reducing the formation, accumulation, or oligomerization of β-amyloid.
No disease-modifying treatments have yet proven efficacious. Many disease-modifying treatments are currently in clinical trials.
Disease-modifying treatments may need to be started at the earliest signs of β-amyloid in the brain-perhaps years or decades prior to the onset of symptoms.

As tangles are further downstream in the cascade that leads to clinical symptoms, treatments directed against
tangles may be more efficacious in patients who have already developed clinical Alzheimer's disease than
treatments directed against β-amyloid. Tangle formation may be the final common pathway in many degenerative diseases and thus treatments directed against tangles may also be efficacious against other dementias such as frontotemporal dementia and chronic traumatic encephalopathy.

NON-PHARMACOLOGICAL TREATMENT OF MEMORY LOSS

* Non-pharmacological treatments to help memory loss can improve function equal to or greater than medication.
* External memory aids such as calendars, lists, and white-boards can be helpful in keeping patients functional.

* It is important to keep the memory aid in the same place.
* Learning habits (using procedural memory) allow patients with even moderate Alzheimer's disease
to improve their function.
* Pictures are easier to remember for patients with Alzheimer's disease.
* The Mediterranean diet or diets high in resveratrol (red grapes, red wine, and blueberries)
or antioxidants have been suggested to reduce memory loss, although their value is currently uncertain.
* Social and cognitively stimulating activities, as found in an enriched environment, have been shown to improve function.
* Aerobic exercise can stimulate the development of new neurons in the hippocampus and improve
cognition, in addition to its effects on cardiovascular health and mood.

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Bathing a patient with dementia/Alzheimer's

Bathing a patient with dementia/Alzheimer's

Music Therapy

Music Therapy